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Drug-resistant Candida auris

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Drug-resistant Candida auris
Other names: Antifungal-resistant Candida auris[1]
  • Top: Mechanisms of drug action and resistance observed in C. auris[2]
  • Bottom: Mutations in C. auris ERG11, TAC1B, and MRR1A contribute to clinical fluconazole resistance.[3]
SpecialtyInfectious disease
SymptomsFever,chills, fatigue(bloodstream infection)[4]
Risk factorsLonger stays in post-acute care facilities ,multiple comorbidities(Diabetes mellitus, chronic pulmonary diseases,cardiovascular diseases)[5][4]
Diagnostic methodAntifungal susceptibility test[6]
Differential diagnosisC. albicans, Aspergillus or Cryptococcus[7][8]
TreatmentResistance to multiple antifungal drugs (however Echinocandins might be effective or liposomal amphotericin B)[9]

Drug-resistant Candida auris spreads primarily in healthcare settings, targeting individuals with weakened immune systems or those using invasive medical devices(catheters or breathing tubes). The fungus can survive on surfaces for weeks, making it difficult to control spread. Symptoms vary depending on the infection site but include fever, chills, and severe complications such as sepsis or organ failure.[10][11]

The Centers for Disease Control and Prevention has labeled it an "urgent threat" due to its rapid spread and high mortality rate in infected individuals. Early detection, strict infection control, and cleaning protocols are crucial in managing outbreaks[12][13] On 26 March the Los Angeles times reported that, "[it was] in hospitals and senior care facilities across the country, killing more than 1 in 3 infected."[14]

Signs and symptoms

As to the presentation of DRCA we find that symptoms vary depending on the location of infection, however generally an individual may experience: [4][15][1]

  • Fever
  • Chills
  • Pain/pressure in the ear (if ear infection )

Risk factors

In terms of the risk factors for DRCS we find the following:[4]

Mechanism

As to mechanism C. auris expression is less pronounced compared to other Candida species. The main reason for its elevated mortality rates is its capacity to acquire resistance to various antifungal medications. The formation of biofilms facilitates the entrapment of drugs within the extracellular matrix, leading to antifungal tolerance seen in Candida species. The matrix can sequester a high percentage of the available triazole antifungal agents, attributed to its abundant mannan-glucan polysaccharides.[8][16][17]

So one could say that C. auris forms biofilms, which are protective layers that shield it .Mutations in genes like ERG11 alter the target site of azole drugs, making them less effective;transcription factors Upc2 and Tac1b regulate pathways that enhance resistance.Finally efflux pumps actively pump antifungal drugs out of the fungal cells[3][17][16]

Diagnosis

As to the evaluation we find that C. auris involves specialized laboratory tests, that is collecting samples from infected areas(blood, urine, or wounds) and performing cultures to identify the fungus.Techniques like MALDI-TOF mass spectrometry or PCR-based methods are often used for accurate identification[6]

Differential diagnosis

Candida glabrata

The DDx of Drug-resistant Candida auris consists of the following:[7][8]

Treatment

In terms of management, the CDC recommends echinocandins as the first-line treatment for both adults and children.[9] For infants under two months of age, a daily dose of 1 mg/kg of amphotericin B deoxycholate is recommended as the usual treatment.[9] Even so, individuals undergoing antifungal therapy for Candida auris should be closely monitored, and susceptibility testing is recommended to identify the most effective treatment approach.[9]

Prognosis

As to the mortality rate for infected individuals can range from 30 to 60 percent. Those with weakened immune systems(or underlying health conditions) are at higher risk of severe complications and therefore a poorer prognosis[18]

Epidemiology

Drug-resistant fungal infection-worldwide distribution of C. auris depicting the clades[10]

Although most strains of Candida auris in the US were susceptible to echinocandins, reports of echinocandin-resistant and pan-resistant cases had increased in 2024.[9]

Candida auris is a drug-resistant fungal pathogen that has been rapidly spreading across the United States and globally; first detected in U.S. in 2016, the number of infections has surged, over 4,500 cases reported in 2023[12]

History

Candida auris, a drug-resistant fungal pathogen, was first identified in 2009 in a hospital patient in Japan. Since then, it has emerged as a global health threat due to its resistance to multiple antifungal treatments and its ability to spread rapidly in healthcare settings[19]

Note

1.^ Due to limited amount of review articles that are Pubmed index, some sources are single-center studies

References

  1. ↑ "Antifungal Susceptibility Testing for C. auris". Candida auris (C. auris). 30 April 2024. Archived from the original on 2 March 2025. Retrieved 27 March 2025.
  2. ↑ Chybowska, Aleksandra D.; Childers, Delma S.; Farrer, Rhys A. (2020). "Nine Things Genomics Can Tell Us About Candida auris". Frontiers in Genetics. 11: 351. doi:10.3389/fgene.2020.00351. ISSN 1664-8021. PMC 7174702. PMID 32351544.
  3. ↑ 3.0 3.1 Rybak, Jeffrey M.; Cuomo, Christina A.; Rogers, P. David (December 2022). "The molecular and genetic basis of antifungal resistance in the emerging fungal pathogen Candida auris". Current Opinion in Microbiology. 70: 102208. doi:10.1016/j.mib.2022.102208. ISSN 1879-0364. PMC 10364995. PMID 36242897.
  4. ↑ 4.0 4.1 4.2 4.3 "About C. auris". Candida auris (C. auris). 24 June 2024. Archived from the original on 27 March 2025. Retrieved 31 March 2025.
  5. ↑ de Cássia Orlandi Sardi, Janaina; Silva, Diego Romário; Soares Mendes-Giannini, Maria José; Rosalen, Pedro Luiz (1 December 2018). Candida auris: Epidemiology, risk factors, virulence, resistance, and therapeutic options. pp. 116–121. Archived from the original on 13 April 2024. Retrieved 30 March 2025.
  6. ↑ 6.0 6.1 Kordalewska, Milena; Perlin, David S. (2019). "Identification of Drug Resistant Candida auris". Frontiers in Microbiology. 10: 1918. doi:10.3389/fmicb.2019.01918. ISSN 1664-302X. PMID 31481947.
  7. ↑ 7.0 7.1 Cortegiani, Andrea; Misseri, Giovanni; Fasciana, Teresa; Giammanco, Anna; Giarratano, Antonino; Chowdhary, Anuradha (29 October 2018). "Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris". Journal of Intensive Care. 6 (1): 69. doi:10.1186/s40560-018-0342-4. ISSN 2052-0492. PMC 6206635. PMID 30397481.
  8. ↑ 8.0 8.1 8.2 Sikora, Anna; Hashmi, Muhammad F.; Zahra, Farah (2025). "Candida auris". StatPearls. StatPearls Publishing. Archived from the original on 2025-02-08. Retrieved 2025-03-29.
  9. ↑ 9.0 9.1 9.2 9.3 9.4 "Clinical Treatment of C. auris infections". Centers for Disease Control and Prevention. 17 June 2024. Archived from the original on 27 March 2025. Retrieved 30 March 2025.
  10. ↑ 10.0 10.1 Sanyaolu, Adekunle; Okorie, Chuku; Marinkovic, Aleksandra; Abbasi, Abu Fahad; Prakash, Stephanie; Mangat, Jasmine; Hosein, Zaheeda; Haider, Nafees; Chan, Jennifer (June 2022). "Candida auris: An Overview of the Emerging Drug-Resistant Fungal Infection". Infection & Chemotherapy. 54 (2): 236–246. doi:10.3947/ic.2022.0008. ISSN 2093-2340. PMC 9259907. PMID 35794716.
  11. ↑ Ademe, Muluneh; Girma, Friehiwot (2020). "Candida auris: From Multidrug Resistance to Pan-Resistant Strains". Infection and Drug Resistance. 13: 1287–1294. doi:10.2147/IDR.S249864. ISSN 1178-6973. PMC 7211321. PMID 32440165.
  12. ↑ 12.0 12.1 "CDC Newsroom". CDC. 1 January 2016. Archived from the original on 11 March 2025. Retrieved 2 April 2025.
  13. ↑ "Tracking C. auris". Candida auris (C. auris). 9 December 2024. Archived from the original on 14 March 2025. Retrieved 27 March 2025.
  14. ↑ "Deadly, drug-resistant fungus CDC calls 'urgent threat' is spreading in hospitals". www.msn.com. Retrieved 27 March 2025.
  15. ↑ Jung, Jiwon; Kim, Min Jae; Kim, Ja Young; Lee, Jeong-Young; Kwak, Sun Hee; Hong, Min Jee; Chong, Yong Pil; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee; Kang, Woo Seok; Chung, Jong Woo; Kim, Mi-Na; Kim, Sung-Han (1 January 2020). "Candida auris colonization or infection of the ear: A single-center study in South Korea from 2016 to 2018". Medical Mycology. 58 (1): 124–127. doi:10.1093/mmy/myz020. Retrieved 4 April 2025.
  16. ↑ 16.0 16.1 Cha, Hyunjin; Won, Doyeon; Bahn, Yong-Sun (3 April 2025). "Signaling pathways governing the pathobiological features and antifungal drug resistance of Candida auris". mBio. 0: e02475–23. doi:10.1128/mbio.02475-23. PMID 40178272.
  17. ↑ 17.0 17.1 Chaabane, Farid; Graf, Artan; Jequier, Léonard; Coste, Alix T. (29 November 2019). "Review on Antifungal Resistance Mechanisms in the Emerging Pathogen Candida auris". Frontiers in Microbiology. 10. doi:10.3389/fmicb.2019.02788. ISSN 1664-302X. PMID 31849919.
  18. ↑ Kim, Hannah Yejin; Nguyen, Thi Anh; Kidd, Sarah; Chambers, Joshua; Alastruey-Izquierdo, Ana; Shin, Jong-Hee; Dao, Aiken; Forastiero, Agustina; Wahyuningsih, Retno; Chakrabarti, Arunoloke; Beyer, Peter; Gigante, Valeria; Beardsley, Justin; Sati, Hatim; Morrissey, C Orla; Alffenaar, Jan-Willem (27 June 2024). "Candida auris —a systematic review to inform the world health organization fungal priority pathogens list". Medical Mycology. 62 (6). doi:10.1093/mmy/myae042. Retrieved 4 April 2025.
  19. ↑ Umeyama, Takashi; Abe, Masahiro; Shinohara, Takayuki; Miyazaki, Taiga; Miyazaki, Yoshitsugu (20 September 2022). "S10.4d A unique clinical appearance of Candida auris infection in Japan". Medical Mycology. 60 (Supplement_1): myac072S104d. doi:10.1093/mmy/myac072.S10.4d. ISSN 1369-3786. PMC 9517935.

Further reading

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